Pain only after bowel movements. Is this PN?

[wick80]

Hi everybody,

I'm writing from Italy. Almost 6 years ago I had pain at my penis tip after an ejaculation. I was treated with ABX for suspected prostatitis (albeit sperm and urine colture showed nothing).

Since then my only pain trigger are bowel movements.

I wake up in the morning feeling fine, but after the BM it slowly start a burning sensation in my perineum that sometimes irradiates at the end of my penis and buttocks. The burning remains all day and ease a bit in the evening. Morning after disappears and comes back only after BM. In the rare days I have no BM, I am pain free.

I have no erection problems. No pain after ejaculation. No pain during and after sex. The pain is not worsened by sitting (maybe a bit only in car, but nothing dramatic). The pain is not worsened by physical activity such as weight lifting, basketball and jump rope.

I saw countless of doctors and did a lot of exams and nothing was found that could clearly explain my symptoms. Except that 2017 I did a PNMLT that showed a bilateral neuropathy of pudendal nerves and sacral nerves S2S3S4.

But I showed the exam to many neurologists and everyone said the exam is not reliable, so it's useless.

In 2016 I got a sacral epidural infiltration with Methylprednisolone 40Mg + 10Mg Ropivacaine with no relief. On the contrary my symptoms worsened. I don't know if that infiltration is to be considered a PN block.

One important thing: in October 2015 I had a penis girth surgery where my body fat was injected to enlarge penis girth. On February 2016 I had a second shot (cause a lot of fat was absorbed after the first one) and after a month the painful ejaculation happened. I asked to many neurologists if the surgery has something to do with my issues and they say the surgery is not the cause, but since then I always wonder if the second shot damaged something and as a result I have this pain. It must be said that before the surgery I always had a couple of painful ejaculations episodes every year, but they always lasted a couple of hours and disappeared after taking Ibuprofen. I don't know if the surgery worsen an issue already going on.

I consulted 5 neurologists and no one diagnosed me with pudendal neuralgia, but they didn't know how to explain the symptoms.

The last one said that maybe is a conditioned response and is probably central pain syndrome.

I tried pelvic floor physiotherapy (rectal trigger points release) and meds with moderate success and recently I'm trying to work on my mind following the TMS theory (mind body syndrome).

In 2017 I had almost 8 months of relief taking Pregabaling 75Mg in the morning + 225Mg in the evening and Paroxeting 20Mg in the evening. I decided to withdraw the meds and after the withdrawal pain came back with vengeance.

Now I'm on Cymbalta 60Mg + Pregabaling (75 morning + 75 evening). Cymbalta since 3 months, Pregabalin since 1 week. Hope the Pregabalin + Cymbalta combo can give me some relief.

This situation causes me a lot of anxiety and depression that I'm trying to keep at bay with the meds mentioned, benzos sometimes, meditation and sport, but it's really difficult.

My questions are.

- Do you think is pudendal neuralgia? Even if my only trigger are BMs?
- The infiltration I got was a PN block or something else?
- Anyone like me here? If yes any suggestions?
- Do you think the penis surgery could have damaged some nerves that are causing this issue?

Sorry for the long post.

Looking forward to your opinions